Background : 3,4-methylenedioxymethamphetamine (MDMA), known recreationally as “Molly” or “Ecstasy”, is a triple monoamine reuptake inhibitor. MDMA specifically acts as a weak 5-HT1 and 5-HT2 receptor agonist, targeting 5-HT 2A , 5-HT 2B , and 5-HT 2C receptors. Its potential use for therapeutic purposes with these pharmacological profiles remains a controversial subject. Studies have shown the potential benefits in clinical trials for post-traumatic stress disorder (PTSD). A larger amount of data has been provided for the push in support of MDMA-assisted psychotherapy in these patients. Objective : The aim of this article is to compute a meta-analysis and conduct a systematic review of the effects of MDMA on PTSD, discussing the potential benefits and adverse events relative to dosing and stability of treatment. Methods : Articles were collected and analyzed for systematic review: 16 articles were included in the systematic review that met the criteria for the use of MDMA in the treatment of PTSD as well as assessing the safety and efficacy of the drug in human participants. Ten studies were used for the meta-analysis, with a cumulative sample size of 168 patients. The significance of the findings on dosing and efficacy of MDMA in healthy human participants was quantified based on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD symptom scores. Results : The disorders for which MDMA demonstrated a net positive or net negative effect on symptoms are presented separately. Adverse events in patients across all disease classes are presented. The therapeutic index for patients who demonstrated a benefit is also presented. An odds ratio for beneficial and adverse events is used to determine treatment-resistant patients who may benefit from clinical trials of MDMA. Discussion : Findings show promising evidence for the potential therapeutic use of MDMA alongside psychotherapy in the treatment of PTSD. The pharmacological profile of MDMA may provide direction for future drug developments to treat patients with treatment-resistant psychiatric disorders.

Antipsychotic treatment has been documented as the mainstay for the management of schizophrenia. Evidence in literature has suggested that the management of negative symptoms of schizophrenia continues to be a treatment challenge. Therefore, residual negative symptoms can become more pervasive and visible after the treatment of positive symptoms, leading to an impaired marked deficit in the vital daily functions of patients. We present a case series of three patients with a past psychiatric history of schizophrenia who presented to the psychiatric emergency with acute symptoms of schizophrenia. Following antipsychotic treatment, all these patients showed improvement of positive symptoms, however, profound negative symptoms of schizophrenia became visible. The negative symptoms include anhedonia, amotivation, alogia, affective flattening, and passive social withdrawal. We added bupropion to manage the negative symptoms, and all three patients achieved a good treatment response. This case series suggests that the anti-depressive effects of bupropion might be a valuable treatment option in the treatment of negative symptoms of schizophrenia.

Autoscopic hallucinations are rare phenomena, with a handful of cases reported in patients with comorbidities and only one in a patient with schizophrenia. This case report discusses a 25-year-old African American female with schizophrenia and auditory hallucinations who presented with autoscopic hallucinations. The patient was interviewed on three separate occasions, her medical chart was consulted, a head computed tomography (CT) was performed, and her serum and urine laboratory values were monitored. Her head CT was normal, and her laboratory values were unremarkable. This case report contributes to the literature on autoscopic hallucinations in patients with schizophrenia.

Major self-mutilation, defined as self-inflicted physical harm without suicidal intent, can be a catastrophic complication of schizoaffective disorder. Oedipism and self-amputation are two sequelae seen in schizoaffective patients. Oedipism is a type of self-mutilation where an individual inflicts an ocular injury to oneself, often leading to blindness. Self-amputation, another complication seen in those with schizoaffective disorder, is defined as the act of deliberately removing healthy limbs. This case report discusses a 39-year-old Ukrainian-American male with a history of schizoaffective disorder who displayed both oedipism and self-amputation behavior of varying extremities. The patient's plan of care was established once an extensive history was obtained and medical records were consolidated. This report contributes to the literature on rare cases of oedipism and self-amputation in patients diagnosed with schizoaffective disorder, depressed type.